title: Diffuse complex regional pain syndrome in an adolescent: a novel treatment approach.
abstract: OBJECTIVE
  Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities.
  
  
  METHODS
  At the time of admission to our hospital, she had been unable to independently perform activities of daily living for several months. We placed an epidural catheter and 2 infraclavicular catheters under general anesthesia and ran continuous infusions of local anesthetic and morphine in the epidural catheter (ropivacaine 0.1% and preservative-free morphine [20 μg/mL] at 8 mL/h) and ropivacaine 0.1% 6 mL/h in each infraclavicular catheter.
  
  
  RESULTS
  Patients were started intense physical, occupational, and psychotherapeutic treatments the following day. Color and temperature of extremities normalized within 10 minutes from the time of the bolus of local anesthetic through the catheters. The patient was able to walk and use her hands 48 hours after the placement of the catheters. She was weaned off opioids during her hospital stay and was discharged home 9 days after her initial admission, and was able to walk and attend to her daily living activities.
  
  
  CONCLUSIONS
  The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.
authors.affiliation: Departments of *Anesthesia Critical Care Medicine †Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cucchiaro
authors.forename: Kevin
authors.initials: K
authors.lastname: Craig
authors.forename: Kerri
authors.initials: K
authors.lastname: Marks
authors.forename: Meghan
authors.initials: M
authors.lastname: Middleton
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002408:Catheters, Indwelling; D020918:Complex Regional Pain Syndromes / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine